Novel case of combination antibiotic therapy for treatment of a complicated polymicrobial urinary tract infection with one organism harboring a metallo-β-lactamase (MBL) in a pregnant patient

• Published in: IDCases Vol. 36; p. e01946
• Main Authors: Ruddy, S., Bapna, M., Karnik, K., Yung, L., Rodriguez, G., Urban, C., Yoon, J., Prasad, N., Segal-Maurer, S., Turett, G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 2024; Elsevier
• Subjects: Ceftazidime-avibactam; Metallo-beta-lactamase (MBL); Pregnancy; Stenotrophomonas maltophilia; Therapy; Stenotrophomonas maltophilia; Pregnancy; Therapy; Metallo-beta-lactamase (MBL); Ceftazidime-avibactam
• ISSN: 2214-2509; 2214-2509
• DOI: 10.1016/j.idcr.2024.e01946

Carbapenem resistance due to metallo-beta-lactamases (MBLs) is a global phenomenon and an important challenge for antibiotic therapy (Boyd et al., 2020 [1]). While previous reports have demonstrated both in vitro and in vivo synergy using the combination of ceftazidime-avibactam and aztreonam against Stenotrophomonas maltophilia, an MBL-harboring organism, this treatment strategy has not been reported during pregnancy (Mojic et al., 2017 [2], [3], Mojica et al., 2016 [4], Alexander et al., 2020 [5]). We describe a 33-year-old pregnant female with polymicrobial, bilateral pyelonephritis caused by Stenotrophomonas maltophilia and other gram-negative bacteria. The organisms were eradicated with the combination of ceftazidime-avibactam and aztreonam followed by successful delivery with no observed adverse effects in either mother or child post-partum.